Research Article: Normative range of blood biochemical parameters in urban Indian school-going adolescents

Date Published: March 7, 2019

Publisher: Public Library of Science

Author(s): Khushdeep Bandesh, Punam Jha, Anil K. Giri, Raman K. Marwaha, Vinod Scaria, Nikhil Tandon, Dwaipayan Bharadwaj, Domenico Tricò.


Adolescence is the most critical phase of human growth that radically alters physiology of the body and wherein any inconsistency can lead to serious health consequences in adulthood. The timing and pace at which various developmental events occur during adolescence is highly diverse and thus results in a drastic change in blood biochemistry. Monitoring the physiological levels of various biochemical measures in ample number of individuals during adolescence can call up for an early intervention in managing metabolic diseases in adulthood. Today, only a couple of studies in different populations have investigated blood biochemistry in a small number of adolescents however, there is no comprehensive biochemical data available worldwide. In view, we performed a cross-sectional study in a sizeable group of 7,618 Indian adolescents (3,333 boys and 4,285 girls) aged between 11–17 years to inspect the distribution of values of common biochemical parameters that generally prevails during adolescence and we observed that various parameters considerably follow the reported values from different populations being 3.56–6.49mmol/L (fasting glucose), 10.60–199.48pmol/L (insulin), 0.21–3.22nmol/L (C–peptide), 3.85–6.25% (HbA1c), 2.49–5.54mmol/L (total cholesterol), 1.16–3.69mmol/L (LDL), 0.78–1.85mmol/L (HDL), 0.33–2.24mmol/L (triglycerides), 3.56–11.45mmol/L (urea), 130.01–440.15μmol/L (uric acid) and 22.99–74.28μmol/L (creatinine). Barring LDL and triglycerides, all parameters differed significantly between boys and girls (p< 0.001). Highest difference was seen for uric acid (p = 1.3 x10-187) followed by C–peptide (p = 6.6 x10-89). Across all ages during adolescence, glycemic and nitrogen metabolites parameters varied markedly with gender. Amongst lipid parameters, only HDL levels were found to be significantly associated with gender following puberty (p< 0.001). All parameters except urea, differed considerably in obese and lean adolescents (p< 0.0001). The present study asserts that age, sex and BMI are the essential contributors to variability in blood biochemistry during adolescence. Our composite data on common blood biochemical measures will benefit future endeavors to define reference intervals in adolescents especially when the global availability is scarce.

Partial Text

Blood tests are routinely prescribed in healthcare systems to analyze the biochemistry to determine a diseased or a healthy state. A panel of blood tests commonly measures metabolic parameters–glycemic (glucose, insulin), lipids (total cholesterol, LDL, HDL, triglycerides), nitrogen metabolites (urea, creatinine, uric acid); important electrolytes (Na+, K+, Cl-, HCO3-) and crucial enzymes (liver aminotransferases and phosphatases, etc.) [1]. These biochemical parameters vary considerably depending upon an individual’s age, sex, ethnicity, dietary intake or physiological state of the body [2–8].

The study was carried out in accordance with the principles of the Helsinki Declaration and approved by Human Ethics Committee of All India Institute of Medical Sciences, New Delhi, India and CSIR–Institute of Genomics and Integrative Biology, New Delhi, India. A written informed consent was obtained from parents/guardians of each participant followed by a verbal consent from participants themselves.

For nearly all studied biochemical parameters, the power of the study was observed to be 100 percent (97 percent for TC) to detect genuine differences between various groups (S1 Table). For LDL and TG, overall comparison among all adolescent boys and girls lacked sufficient power, however their individual comparisons at specific age groups secured necessary power.

Rapid growth and development during childhood administer normal circulating levels of various biochemical markers. Abnormal levels of such markers are classical indications that can potentially signal an underlying pediatric disease or early signs of an adult onset disease. These levels are strongly influenced by their rate of growth, organ maturity, hormone responsiveness, nutrition and metabolism [31, 32]. Additionally, children are immunologically naive and respond differently to infections, therefore adult normative values of various biochemical markers are not applicable in a pediatric setting. Given this background, we aimed to establish normative range of commonly studied blood biochemical parameters in Indian adolescents.




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